Kennedy Institute of Ethics Journal

This issue of the Kennedy Institute of Ethics Journal continues two conversations that have been developing in this journal over the last few years, and introduces a new and timely one. Kevin Elliot and Paul Mushak’s paper, “Structured Development and Promotion of a Research Field: Hormesis in Biology, Toxicology, and Environmental Regulatory Science,” continues an ongoing debate in this journal over the role of values in shaping scientific methodology and communication, and how this role should be managed at the level of policy. We inaugurated this discussion in our June 2012 special issue on Science, Expertise, and Democracy, and have followed up with multiple articles on science and values. David Buchanan’s “Promoting Justice and Autonomy in Public Policies to Reduce the Health Consequences of Obesity” and Stephanie Morain’s “Evaluating the Legitimacy of Contemporary Legal Strategies for Obesity” both continue our discussion here at the journal concerning appropriate policy responses to the so-called “obesity epidemic.” In particular, they build on other attempts here to develop food policies that are grounded in sophisticated and satisfactory conceptions of justice and agency. This conversation dates back to our September 2014 special issue on “Regulating Bodies in the ‘Obesity Era’: Ethical, Social, and Legal Perspectives.” Again, we have published several articles on this topic since the special issue appeared. The journal is proud to be hosting both of these ongoing conversations.

Elliot and Mushak give a close reading of how research on “hormesis”— the phenomenon of a substance producing opposite effects at low and high doses—has been strategically managed in both its methodology and its presentation and dissemination. They show how one invested researcher, Edward Calabrese, has managed to shape the perception of the phenomenon substantially, through his use of aggressive techniques to study, attract attention to, and advocate for the phenomenon and to silence critics. They show how the language, study design, and marketing of the phenomenon encourage our acceptance of its reality and importance. [End Page vii] While science becomes more and more driven by private interests, this case study shows vividly the multifaceted ways in which these interests can shape what we know, what we don’t know, and how we interpret what we know. Elliot and Mushak do not argue for resuscitating the concept of value-free science, but rather for increased scrutiny of how interests shape science, and for the development of policies for how to interrogate and control for these interests.

Buchanan and Morain are both interested in making sure that we use rich and sophisticated conceptions of justice and personal agency when thinking through the ethics of public health interventions designed to address obesity. Both wish us to move beyond the simple opposition between “freedom,” understood thinly as unrestricted consumer choice, and “paternalism,” which often includes policies designed to control food intake that are often regressive, predictably ineffective, or assaults on dignity. They draw on different theoretical tools to do this: Buchanan adapts Amartya Sen’s capabilities approach to thinking about justice, while Morain draws on John Rawls’s principle of legitimacy. In both cases, though, justice is portrayed as something more robust and more supportive of people’s agency, dignity, and capacities than mere equal divisions of resources or opportunities for choice. Buchanan argues that the capacity for exercising autonomy is itself unjustly distributed, and that any attempts to address unhealthy behaviors justly must begin from an understanding of that underlying problem. Morain offers a detailed critique of Mill’s harm principle as a tool for determining which restrictions on behaviors are just; this principle, she claims, offers no mechanisms for distinguishing between acceptable and unacceptable impositions on one another’s well-being. Instead, she suggests we focus on prioritizing access and protection to basic liberties. Each author ends up with a subtler approach to food policy than one that focuses on the dichotomy between “free” choice and top-down behavioral control.

Finally, Miller and Kim discuss consent in the context of “learning health care systems”—that is, systems that deliver a mixture of personalized care and randomized care that contributes to randomized controlled trials that meet the standards of equipoise. According to one school of thought, since...